St. Louis Eating Recovery Therapy, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ST. LOUIS EATING RECOVERY THERAPY, LLC

Practice address

140 Prospect Ave Ste L
Kirkwood, MO 63122-6024

Phone

(314) 896-0810

NPI assigned

Apr 24, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole Jacobs, LPC, CEDS-SNPI 1528595584

Title

Owner/Therapist

Phone

(314) 609-1874

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicole Jacobs, LPC

  • Professional Counselor
  • Kirkwood, MO
  • NPI 1528595584
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619222400000",
    "number": "1528640075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 S PAM AVE",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633014866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 PROSPECT AVE STE L",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631226024",
            "telephone_number": "314-896-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS EATING RECOVERY THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-24",
        "last_updated": "2021-04-24",
        "certification_date": "2021-04-24",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "314-609-1874",
        "authorized_official_credential": "LPC, CEDS-S"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Kirkwood, MO
• Providers in Kirkwood, MO by specialty
• Community/Behavioral Health Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.